• Mindless Medicine: When Will Doctors Ever Curb The Needless Care?

    Posted April 17, 2013: by Bill Sardi

    Your doctor shows he/she cares for you by conducting preventive exams.  Few patients would argue with that measure of a doctor.  But what if the preventive measure is needless?  What if the “care” is a test that leads to treatment that harms?

    The problem in today’s world where insurance pays and the patient doesn’t is that no one, doctor or patient, cares.  A billing code exists for tests such as PSA for prostate cancer among males and pap smears to detect early cervical cancer in females.  But various health groups now say both tests are of near-worthless value.  But the billing code still persists and reimbursement submissions continue.  Who will ever put a stop to this?

    A task force recommended against PSA testing for men over age 75 years in 2008.  Wouldn’t it be simple for health insurance plans to simply deny reimbursement for these tests?  Well, it’s not that easy says an expert physician.  For one thing, for a variety of reasons, doctors don’t agree with these recommendations says Dr. Mitchell Katz MD, writing in the JAMA Archives of Internal Medicine.  “It’s not like PSA tests are harmless, Dr. Katz says, some men will go on to be misdiagnosed and undergo needless surgery and/or subsequent complications like incontinence and erectile dysfunction.

    Doctors punt on the issue and often ask their patients if they want a PSA test.  The patient is in no position to judge whether a PSA test is needed or whether it will be misleading.

    As Dr. Katz asks:  “Should we be offering our patients a menu of ineffective interventions on the idea that they are better able than we are to determine effectiveness?  So doctors are playing footsy with this issue (“the patient made me do it”).

    Many male patients like a number to watch.  They feel more secure with a numerical test.   It just may be something so ingrained it cannot be halted, save for banning the sale of equipment to perform the tests.

    If perpetual PSA tests don’t create an outrage, how about doctors who continue to perform pap tests to detect cervical cancer among females who have undergone hysterectomy and have no cervix?  Less than 20% of physicians follow current guidelines for pap tests which say pap tests on hysterectomy patients are needless.  Writing in the Minnesota Post, Dr. Michael L. LeFevre, a professor of family medicine at the University of Missouri, says: “First, the noble ambition of physicians is to do good.  Unfortunately, this ambition is too often accompanied by either the failure to recognize or the ability to ignore harm. A ‘don’t just stand there, do something’ approach is supported by what appears to be a strong cultural belief within the public that medical care can only do good, not harm, and that more care is always better than less.”

    Evidence-based medicine will never become a reality.  The patients need a lot of hand-holding and false assurances, doctors need to show they care.  If one doctor doesn’t perform a PSA or a PAP test and another does, betcha the patients are going to think the doctor who DID perform these tests was the better doctor.  Doctors know this and don’t want to lose the patients to a competitor.  So the mindless tests are performed in perpetuity.  ©2013 Bill Sardi, Knowledge of Health, Inc.

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